Managing Postoperative Pain With Fewer Opioids: The Ultrarestrictive Opioid Prescription Protocol
Patients who have surgery at Roswell Park will be prescribed the minimum number of opioids necessary to control their pain following surgery and surgical procedures. Known as the ultra-restrictive opioid prescription protocol for postsurgical pain management, the guideline is meant to effectively manage pain while reducing the potential long-term side effects of these narcotics and helping to prevent the potential misuse of opioids. These guidelines are for post-surgical patients only and not those with chronic cancer pain.
Our neurosurgeons employ a technique called electrocortical mapping to provide the greatest measure of safety during brain tumor removal. Because areas of the brain that control speech and motor function look very similar to other brain areas with little known function, they are at risk for injury during brain tumor surgery.
During electrocortical mapping, the patient remains awake. The brain has no nerve endings that register pain, so the patient experiences no discomfort. The patient responds verbally to a series of images displayed on a computer monitor, while the neurosurgeon stimulates the surface of the brain with a very mild electrical current. The patient’s responses enable the surgeon to determine which areas control important functions (such as speech), and to map the boundaries between the tumor and healthy tissue.
After surgery removes all visible tumors, heated chemotherapy drugs are circulated throughout the abdominal wall. Because the drugs are restricted to the abdomen, very high doses can be used to kill cancer cells more effectively, while reducing the drugs’ side effects on other healthy tissue and organs. Roswell Park is the only center in New York State to offer this cutting-edge therapy.
Also known as minimally-invasive surgery, laparoscopic surgery is a way of performing an operation where the surgeon operates through several tiny incisions, called ports, incisions, rather than one large incision that’s used in “open” or “traditional” surgery. A special camera called a laparoscope, is inserted through one port, transmitting a high-resolution, magnified view inside the body, while the surgeon operates special surgical instruments through the other ports.
Laser Interstitial Thermal Therapy (LITT) or Visualase
This minimally invasive neurosurgery uses heat to ablate or destroy cancerous or other damaged tissue in the brain. Through a tiny incision (less than 2 cm) a laser probe delivers light energy to the target, heating the target area and destroying the unwanted tissue. The procedure is performed under MRI-guidance so the neurosurgeon can monitor the temperature of the target area and have real-time confirmation that all the necessary tissue has been ablated and the normal brain has been preserved. The treatment does not require a large incision. Patients typically return home the day after the procedure.
LITT, which also goes by the brand name of Visualase, may be an option for patients with primary brain cancers, gliomas, metastases to the brain, for cancer that’s recurred after radiation or Gamma Knife therapy, and to treat noncancerous conditions such as epilepsy. LITT may also ablate areas of radiation necrosis (swelling or edema caused by prior radiation therapy) in the brain.
LITT is available only at select centers across the nation; Roswell Park is the only such center offering the treatment in the Western New York region.
Mohs Surgery (or Mohs Micrographic Surgery) is a technique used to treat skin cancer. The purpose of the procedure is to completely remove all of the cancer while leaving normal skin tissue alone. Mohs Surgery is a highly specialized surgical technique where the surgeon examines all tissue removed for evidence of cancer cells.
Plastic & Reconstructive
- Head & Neck: Roswell Park’s plastic & reconstructive surgeons provide a full menu of services to preserve or restore the function and/or appearance of any region of the body. They work closely with surgical oncologists at Roswell Park as well as surgeons from outside centers to solve a broad range of complex problems, including those related to cancer, trauma, pressure ulcers, and delayed effects of chemotherapy or radiation treatment.
- Breast: We use the latest modern techniques to provide more options than ever before to repair, improve or completely reconstruct human breasts
Portal Vein Embolization
The main vein associated with the liver tumor is blocked (embolized) which causes the healthy part of the liver to grow, to allow for a safer liver surgery to remove the tumors.
Robot-assisted Surgery or Robotic Surgery
Robotic surgery is a type of laparoscopic procedure in which the surgeon uses a computer to manipulate the robotic surgical instruments. Laparoscopic surgical procedures are used for many disease sites, especially for gynecological, gastrointestinal, colorectal, and urologic conditions. [head & neck]
Skull Base Surgery
Surgery to treat diseases and conditions, both malignant and benign at the base of the skull, the underside of the brain and the top of the spinal column. Skull base surgery is extremely delicate and complicated—the body’s most critical nerves, blood vessels and spinal cord all pass through this small, crowded area at the base of the skull. Roswell Park’s team includes highly-trained and experienced head & neck surgeons, neurosurgeons, plastic & reconstructive surgeons and radiologists. Tumors and lesions in the skull base, particularly those in the lateral and anterior portions are difficult to reach is difficult to reach. Roswell Park’s surgeons employ the latest surgical techniques to reach these sensitive areas in the least invasive way possible. When highly invasive surgery is the only option, our Plastic & Reconstructive surgeons work with the head & neck surgeons to restore optimal function and appearance. Other skull base surgical options we offer include:
- Endoscopic endonasal surgery: An endoscope passed through one nostril provides images of the surgical site, while surgical instruments passed through the other nostril enable the head & neck surgeon to open the area leading to the tumor. The neurosurgical team then removes the tumor.
- Skull base surgery with partial facial translocation: To gain access to the tumor site, in essence head & neck surgeons create a hinged “door” by splitting the mid-face. This “door” can swing open to allow neurosurgeons to reach the tumor and then close when the excision is complete. The team’s plastic & reconstructive surgeons then complete the surgery to provide the best postsurgical appearance. This creates a wide surgical field for greater precision and offers the benefit of immediate reconstruction.
Transoral Robotic Surgery (TORS)
We offer Transoral Robotic Surgery (TORS) for the treatment of certain head & neck cancers. TORS helps preserve the ability to swallow, and it may also eliminate or reduce the need for radiation treatments after surgery. Compared with traditional surgery, it has been shown to speed recovery and is associated with less pain.
Video Assisted Thoracic Surgery (VATS)
Video-assisted thoracic surgery (VATS) offers a minimally invasive surgical alternative with many benefits for the patient. Nationally, only 20-30 percent of lung surgeries use the VATS approach, but at Roswell Park, the rate of using VATS is as high as 90 percent. Roswell Park is the world leader in the number of VATS procedures for removal of a lung. The entire surgical team incorporates minimally invasive techniques into lung cancer treatment.
Our surgeons make three small incisions, or ports. A scope equipped with a camera is inserted through one port, providing an interior view of the chest, while surgical instruments are inserted through the other ports.